HIV Prevention Action Coalition

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1 HIV Prevention Action Coalition National HIV/AIDS Strategy Agency Implementation Plan Suggestions 1.1 Allocate public funding to geographic areas consistent with the epidemic: HHS/, HRSA HHS/, SAMHSA, HRSA, HUD HHS OS/, HRSA /PGO HHS OS/ These agencies will make financial allocations based on the most recent comprehensive data. These agencies will meaningfully involve the HIV community in plans to redesign the distribution of resources and models should be vetted with key stakeholders. Reveal data sets and algorithms used for determining the existing allocation of HIV prevention funds and ensure greater transparency in decision-making and resource allocation for future allocation models. Set clear expectations of community involvement in targeted initiatives such as the Enhanced Comprehensive HIV Prevention Planning and Implementation (ECHPP) project being implemented in 12 most highly impacted MSAs (Metropolitan Statistical Areas). Provide and enforce guidance through funding opportunity announcements to ensure that federal resources are distributed in accordance with jurisdiction-level epidemiology. Create new mechanisms to ensure that and PGO can effectively monitor and evaluate its HIV prevention grantees to ensure that outcomes are being achieved, and to work with jurisdictions as necessary if funding is not following the epidemic among and within their jurisdictions. HHS OS/, HRSA HHS OS and relevant agencies will host consultation with the 6 US affiliated Pacific Island jurisdictions to ensure that the unique needs and challenges of this region are considered when allocating prevention funding to targeted populations and communities. 1

2 1.2 Target high risk populations: HHS OS/, HRSA HHS/ONAP HHS OS/ /HRSA, SAMHSA, HHS OS Ensure that community stakeholders are involved in all aspects of prevention and care service planning and policy development. Meaningful engagement extends beyond existing CPG, planning councils and consortia. Provide greater transparency in decision-making and resource allocation based on targeted populations. Work with states to develop statewide plans with input from the high risk populations within the jurisdiction and with the local health departments in these jurisdictions. These plans should include dedicated sections that address the most severely impacted populations and geographical areas within the jurisdiction. Create new mechanisms to ensure that and PGO can effectively monitor and evaluate HIV prevention grantees to ensure that outcomes are being achieved, and to work with jurisdictions as necessary if funding is reaching the most at risk populations. Develop and implement a plan of recommended action steps for reducing the proportion of HIV-positive AA and NHPI individuals with undiagnosed HIV infection. Currently, estimates that nearly 1/3 of AA and NHPIs living with HIV/AIDS are unaware of their status. This is the highest proportion across all racial/ethnic groups Prevent HIV among gay and bisexual men and transgender individuals: Review and revise HIV testing guidelines for MSM, bisexual and transgender individuals. Revised guidelines should address 2

3 frequency of testing and focus on behavior rather than identity. Broaden the list of approved MSM focused HIV prevention interventions which can be implemented in 2011 and target risk reduction strategies at the level of the individual, their social network, and community. Implement multifaceted strategies that reduce social and behavioral risk behaviors. Review partner service guidelines and make adjustments as necessary. Expand its work evaluating adaptations of specific interventions for gay and bisexual men as well as transgender populations, including AA&NHPIs. An initial starting point would be a report that documents previous and current adaptation efforts for AA&NHPI populations. Develop a comprehensive action plan to reduce HIV infections that focus on gay and bisexual men and transgender individuals. / HRSA, SAMHSA, VA, CMS, / HRSA, SAMHSA, VA, CMS, / HRSA, SAMHSA, VA, CMS, /HRSA, SAMHSA, VA, CMS, /NIH Revise strategy to promote HIV testing specifically within MSM, bisexual, and transgender communities of color. Support research being conducted (or fund research to be conducted) within transgender communities. LGBT cultural competency training should be required for all programs receiving funding. Work with the Congress to end the no promotion of homosexuality restrictions. Conduct research on the extent to which the HIV epidemic among AA&NHPI females is perpetuated through unprotected sex with MSM partners. Based on this research, should develop recommendations for essential prevention activities and services. NIH Immediately invest resources to research and develop evidencebased interventions for gay, bisexual, and transgendered 3

4 individuals which provide strategies that will support life-long HIV prevention behaviors. DOJ DOL HHS HHS OS ONAP SAMSHA Ensure greater enforcement of employment and housing discrimination protections to increase economic security among gay, bisexual, and transgendered individuals. Work with health care and social support service providers to better integrate vocational education programs to enable HIVpositive MSM to build economic security. Fully implement and provide adequate resources for an Office of LGBT Health Policy and Programs. In convening consultations to address HIV prevention among gay and bisexual men, HHS OS and related agencies should ensure representation from AA and NHPI communities. Conduct a consultation with MSM, bisexual, and transgender communities. Invest in further research to better understand how substance use affects HIV vulnerability among gay, bisexual, and transgendered persons Prevent HIV among Black men and women: Include cases averted, decreasing stigma, and how education has increased in the evaluation of Act Against AIDS. Expand its work evaluating adaptations of specific interventions that involve faith communities. Expand its work evaluating adaptations of specific interventions that focus on women directed prevention. Enhance prevention and testing activities of HIV/AIDS and sexually transmitted infections (STIs) targeted to the African American community, including homeless youth. 4

5 Work with state and local health departments to support a surveillance system that captures HIV incidence and prevalence for black women. The system should also be able to delineate age groups, and modes of transmission to allow for greater access to women centered programs and care across all federal agencies. DOL NIH NIH ONAP HHS/ONAP Provide new professional development opportunities to increase the number and skills of service providers for enhanced awareness of Community Defined Evidence-Based Interventions (aka Homegrown ) and improve upon culturally competent curricula in a way that better serves diverse African Americans. Initiate culturally competent research to develop behavioral strategies to reduce the transmission of HIV/AIDS within the African American community. Increase funding to conduct culturally competent vaccine research by and for African Americans. Conduct a consultation with black heterosexual men. Coordinate social marketing plans and outreach with black media Prevent HIV among Latinos and Latinas: HHS/ HUD /HRSA, SAMHSA, VA, CMS,, OPM, ONAP / NIH Declare a heightened national response to address the epidemic among Latinos. Assure access to culturally competent and linguistically appropriate quality care and prevention. Assist Latino prevention providers in the development, implementation and evaluation of local solutions and home grown interventions. Improve the understanding of factors that contribute to HIV risk among Latinos. 5

6 /NIH, HRSA Work with state and local health departments to support a surveillance system that captures HIV incidence and prevalence for Latinos. The system should also be able to delineate age groups, and modes of transmission to allow for greater access to programs and care across all federal agencies. Increase HIV prevention resources targeted toward Latinos. Develop strategies for combating stigma Prevent HIV among substance users: HHS/ SAMHSA SAMHSA Fast track development of guidance for requiring federally funded mental health and substance abuse service providers to implement routine screening for HIV and should indentify resources to fund demonstration projects which target high risk populations and geographic areas with HIV rates of substance use and significant HIV prevalence. Clarify its funding streams and programs which impact HIV transmission, and include the HIV prevention, mental health and substance use communities in resource allocation deliberations. HHS OS HHS OS HHS OS Create opportunities for dialogue among community mental health and substance abuse providers, community health centers, HIV/AIDS service organizations and non-governmental organizations across each of these sectors in order to identify potential strategies and collaborative initiatives to reduce HIV transmission among substance users. Work with Congress to allow for use of Ryan White funds for syringe exchange. Expedite development of guidance for the use of federal funds for syringe services programs in FY 2011 and beyond and seek opportunities to ensure that eligible locations are able to use funding in

7 1.3 Address HIV prevention in Asian American and Pacific Islander (AAPI) and American Indian and Alaska Native (AI/AN) populations: / HRSA /SAMHSA, NIH / SAMHSA Convene an external working group consisting of health department and CBO representatives to identify recommendations on effective HIV surveillance activities. In particular, this working group should identify strategies to 1) ensure that Asian American, Native Hawaiian, and Pacific Islander (AA & NHPI) and AI/AN data is reported in tables, charts, and graphs related to racial/ethnic level HIV/AIDS data; 2) discourage the practice of lumping AA & NHPI and AI/AN data into an Other category when racial/ethnic level HIV/AIDS data is reported; and 3) disaggregate AA & NHPI data by ethnic subgroup. Incorporate these recommendations into future HIV surveillance cooperative agreement and technical guidance for health departments. Monitor and provide capacity building assistance related to these recommendations. Ensure that there are multiple AA & NHPI representatives on the /HRSA Advisory Committee on HIV and STD Prevention and Treatment. These representatives should have personal or professional experience with domestic HIV prevention and/or care efforts with AA & NHPI communities. Convene a joint consultation and/or external working group with state health department and CBO representatives from the states with the largest AA & NHPI communities with the purpose of identifying the best combination of approaches to prevent HIV that reach AA & NHPIs at greatest risk for infection. Additionally, the agencies will prioritize research gaps for AA & NHPI communities (including the dearth of evidence based interventions) and identify strategies/funding opportunities to fill these gaps. Support state health departments in increasing AA & NHPI representation on state community planning groups and increasing the awareness and attention of CPGs to the growing HIV epidemic among AA and NHPI communities. Increase HIV prevention resources to CBOs and health departments to address the epidemic among AA & NHPI communities. This is inclusive of efforts to prevent HIV in the 6 US Affiliated Pacific Island jurisdictions. 7

8 1.4 Enhance program accountability: HPAC supports the proposed implementation plan for this recommendation but suggests that the Office of Women s Health and Office of Minority Health be included as Other agencies that should be involved. 2.1 Design and evaluate innovative prevention strategies and combination approaches for preventing HIV in high risk communities: HPAC does not have any additional agency implementation steps for this item. 2.2 Support and strengthen HIV screening and surveillance activities: /AHRQ /HRSA, SAMHSA, VA, CMS,, OPM CMS/ CMS Lead an effort to support an improved grade for routine testing by the US. Preventive Services Task Force (USPSTF). Work with other federal agencies and state and local health departments to review their current testing programs and policies, identify barriers to increased testing and implement necessary changes. Develop and implement a plan to ensure routine testing recommendations are utilized; release guidance for the various health care settings that have not yet been released; work with professional medical and nursing organizations; conduct social marketing campaigns. Issue testing recommendations for non-clinical settings. Update testing algorithms for rapid tests at point of care. Work with states to develop model programs and guides, and conduct cost effectiveness studies to share with states on coverage of routine testing in state Medicaid programs. These agencies will offer technical assistance to states. Update coverage determination for testing those who are at risk for HIV to match USPSTF recommendation. 8

9 CMS /CMS, HRSA HRSA/ HRSA SAMHSA VA OPM /CMS HRSA Encourage Medicare providers to conduct testing in accordance with current coverage determination and include HIV testing in annual wellness visit; review coverage determination to include routine HIV testing. Continue to fund testing programs and ensure they are targeted to areas where the most undiagnosed number of people are located. Identify how HIV testing can be increased through the implementation of health reform. Implement testing provisions of the Ryan White HIV/AIDS Treatment Extension Act of 2009 and develop both a national estimate of the number of individuals who may initiate antiretroviral therapy under the new treatment guidelines as well as provide a methodology/model for estimating that jurisdictions could use to generate local estimates. Ensure that Community Health Centers and Title X clinics implement routine testing recommendations. Ensure that SAMHSA funded clinics implement routine testing recommendations. Ensure that federally run and funded prisons implement routine testing recommendations. Ensure that all Veterans Affairs facilities implement routine testing recommendations. Include coverage of routine HIV testing in the Federal Employee Health Benefits Program. Work with the Congress on legislation to increase the federal matching rate for state Medicaid programs for routine HIV testing. Include routine HIV testing as it determines which prevention programs will be covered by private insurers for women. Work with professional medical organizations to develop a code for routine HIV testing, counseling and prevention services, and new testing technologies. 9

10 Take appropriate steps (including financial and capacity building resources) to strengthen core state/local HIV surveillance systems and for expanding them nationwide to generate the additional data needed for measuring progress in meeting the Strategy s goals. Provide technical assistance to state and local health departments on the extended back calculation model of measuring incidence and methodologies for assessing community viral load. 2.3 Expand access to effective prevention services: / DOJ Conduct testing upon admittance and exit from prisons. Educate within the on prevention for both HIV positive and negative people. Develop strategies to ensure confidentiality for HIV positive people in prisons. Eliminate isolation within prisons for HIV positive people. Distribute condoms within prisons and upon release. Coordinate care upon release with a community health center or care center. Issue a 30 day med supply to all HIV positive people upon release from prison. Ensure continuity of care for those admitted to prisons who have HIV. Develop specific interventions, targeted at both incarcerated and re-entry populations. They should address the undiagnosed and untreated upon re-entry into the community. 10

11 Remove current voluntary HIV testing policy that limits inmate requests for tests to no more than 1 per 12 month period Ensure timely treatment follows HIV/STD/viral hepatitis screening and diagnosis 2.4 Expand prevention with HIV-positive individuals: HRSA/ /CMS /NIH HRSA/CMS Work with Ryan White grantees to encourage providers to offer prevention messages to all clients, and include sexual health as part of care and treatment. Clients should also be provided mental health and substance abuse services along with treatment adherence counseling. Ensure that HIV beneficiaries who obtain care through Medicaid and Medicare receive prevention messages. Allocate funding and ensure grantees allocate adequate funding for prevention with HIV-positive individuals. Explore coverage of prevention for positive interventions through health reform implementation. Conduct research on effective prevention interventions for people who are HIV positive and on how providers can better carry out these interventions. Ensure that people who are HIV-positive receive counseling and testing for STDs. HRSA/CMS//SAMHSA Ensure that people who are HIV-positive are offered testing for hepatitis B and C and vaccination for hepatitis A and B. /HRSA,CMS,VA SAMHSA Develop and disseminate information on the positive impacts of HIV treatment. Integrate mental health and substance abuse services in the service provision continuum for HIV positive people. 11

12 3.1 Utilize social marketing and education campaigns: ONAP OPM HHS HHS HHS HHS HHS/ONAP, Lead a national testing initiative, with public service announcements with the President and First Lady. The President, First Lady, and cabinet members will also be tested. Support testing for all federal employees through a federal workplace initiative. Create materials for social marketing and education on the community level, that can be implemented by community based organizations and/or local health departments with a toolkit created to target specific audience of the community. Create a better evaluation system for campaigns to ensure effectiveness. Measurable and effective standards should be created to measure result of campaign. Create tools to support local health departments on how to engage local media leaders. Create tools to support local health departments on how to target local business leaders. Build upon World AIDS Day and National HIV Testing Day, by extending campaigns beyond these two days, adapting programs to local communities to get local advocates, media, and business leaders to better reach target audiences year-long and targeting communities based on local days of significance to both HIV/AIDS and their communities. 3.2 Promote age-appropriate HIV and STI prevention education for all Americans: HHS/ONAP, DOE Work with ONAP and DOE to include health education, including comprehensive sex education, in the reauthorization of the Elementary and Secondary Education Act as its role in 12

13 implementing the NHAS. HHS/DOI HHS/ HHS//DOE HHS//DOE HHS/ Work with the Department of the Interior to include Native American school-age children in comprehensive sex education. Develop resources so that comprehensive sex education can be provided in juvenile detention centers, foster care facilities, etc. Require within the Division of Adolescent and School Health (DASH) that state education agencies and the local education agencies they fund must work together with their state or local departments of health. Develop and disseminate tools and resources, including supporting comprehensive sexuality curricula, which includes positive images of LGBT individuals and addresses homophobia and stigma. Create tools to increase prevention resources for women and girls. The comprehensive sex education provided to women and girls should specifically address healthy relationships, selfesteem, and raising awareness of their own risk, among other topics. Develop and implement prevention strategies for older Americans who are potentially at risk for HIV infection. These strategies will include age-appropriate and culturally sensitive information and education to increase awareness and knowledge about HIV among older Americans and skills-based education to help them negotiate risk-reduction behaviors, such as condom use. HHS/DOE Ensure condoms are available in schools. This document was prepared by the Federal AIDS Policy Partnership (FAPP) HIV Prevention Action Coalition (HPAC). For further information, please contact the HPAC co-chairs: Carl Schmid of The AIDS Institute Suzanne Miller of the National Coalition of STD Directors or Jen Heitel Yakush of the Sexuality Information and Education Council of the U.S. October 15,

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